Nemade Hemant, Thaduri Abhinav, Gondi Jonathan T, Chava Sravan Kumar, Kumar Anil, Arya Sahithi Shilpa, Sekara Rao S L M Chandra
Head and Neck Services, Department of Surgical Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India.
Head and Neck Services, Department of Surgical Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India.
Oral Oncol. 2025 May;164:107281. doi: 10.1016/j.oraloncology.2025.107281. Epub 2025 Mar 29.
Extranodal extension (ENE) is an important prognostic factor in oral squamous cell carcinoma (OSCC), often associated with poor survival outcomes. However, the current nodal (N) staging system may need to be revised to reflect the prognosis. Emerging evidence suggests that the number of positive lymph nodes may offer improved prognostic accuracy. This study evaluates the outcomes of OSCC patients with pathological ENE (pENE) and explores the prognostic significance of absolute positive lymph node count.
This retrospective cohort study analyzed 640 OSCC patients with pENE who underwent curative-intent surgery and standard adjuvant therapies between May 2015 and December 2021. Receiver Operating Characteristic (ROC) curve analysis was performed to identify a cutoff for the number of positive lymph nodes predicting overall survival (OS). Survival analyses were conducted using Kaplan-Meier curves, and Cox proportional hazards regression was used to identify independent predictors of OS and disease-free survival (DFS).
In the entire cohort, the median DFS was 16 months (95 % CI: 12-19), and the mean OS was 57 months (95 % CI: 52-62). ROC analysis identified four positive lymph nodes as the optimal cutoff for predicting OS (AUC = 0.562, p = 0.01), with a sensitivity of 46.3 % and specificity of 65.2 %. Patients with > 4 positive lymph nodes had significantly poorer outcomes compared to those with ≤ 4 nodes: median DFS was 9 months vs. 21 months (p < 0.001), and mean OS was 26 months vs. 61 months (p < 0.001). Multivariate Cox regression confirmed the number of positive lymph nodes as an independent predictor for OS (HR = 0.6, p < 0.001) and DFS (HR = 0.5, p < 0.001).
Patients with pENE and > four positive lymph nodes have significantly worse survival outcomes despite standard adjuvant therapies. This highlights the need for improved risk stratification in the current nodal staging system. These findings suggest incorporating lymph node burden into staging frameworks could improve prognostic accuracy.
结外扩展（ENE）是口腔鳞状细胞癌（OSCC）的一个重要预后因素，常与较差的生存结果相关。然而，当前的淋巴结（N）分期系统可能需要修订以反映预后情况。新出现的证据表明，阳性淋巴结的数量可能提供更高的预后准确性。本研究评估了患有病理结外扩展（pENE）的OSCC患者的预后，并探讨了绝对阳性淋巴结计数的预后意义。
这项回顾性队列研究分析了2015年5月至2021年12月期间接受根治性手术和标准辅助治疗的640例患有pENE的OSCC患者。进行了受试者操作特征（ROC）曲线分析，以确定预测总生存期（OS）的阳性淋巴结数量的临界值。使用Kaplan-Meier曲线进行生存分析，并使用Cox比例风险回归来确定OS和无病生存期（DFS）的独立预测因素。
在整个队列中，中位DFS为16个月（95%CI：12-19），平均OS为57个月（95%CI：52-62）。ROC分析确定四个阳性淋巴结为预测OS的最佳临界值（AUC = 0.562，p = 0.01），敏感性为46.3%，特异性为65.2%。与阳性淋巴结数≤4个的患者相比，阳性淋巴结数>4个的患者预后明显更差：中位DFS分别为9个月和21个月（p < 0.001），平均OS分别为26个月和61个月（p < 0.001）。多变量Cox回归证实阳性淋巴结数量是OS（HR = 0.6，p < 0.001）和DFS（HR = 0.5，p < 0.001）的独立预测因素。
尽管接受了标准辅助治疗，但患有pENE且阳性淋巴结数>4个的患者生存结果明显更差。这凸显了当前淋巴结分期系统中改善风险分层的必要性。这些发现表明，将淋巴结负担纳入分期框架可以提高预后准确性。
